title: A validated model for predicting outcome after liver transplantation: implications on transplanting the extremely sick.
abstract: Given the organ shortage, there is a need to optimize outcome after liver transplantation (LT). We defined posttransplant hospital length of stay > 60 days (LOS > 60) as a surrogate of suboptimal outcome. In the first phase of the study, a 'Study cohort' (SC) of 643 patients was used to identify risk factors and construct a mathematical model to identify recipients with anticipated inferior results. In the second phase, a cohort of 417 patients was used for validation of the model ['Validation Cohort' (VC)]. In the SC, 65 patients (10.1%) had LOS > 60 days. One- and 3-year patient/graft survival rates were 81.9%/76.1% and 73.4%/67.4%, respectively. Patient and graft survival rates of those with LOS > 60 days were inferior (P < 0.0001), while transplant cost was greater [3.42 relative units (RU) vs. 1 RU, P < 0.0001]. In a multivariable analysis, pretransplant dialysis (P < 0.001), mechanical ventilation (P < 0.015), MELD (P < 0.003), and age (P < 0.009) were predictors of LOS > 60 days [ROC curve - 0.75 (95% CI 0.70, 0.81)]. In the VC, 53 patients (12.7%) were expected to have adverse outcome by the model. These patients had longer LOS (P < 0.0001), higher cost (<0.0001), and inferior patient and graft survival (P < 0.007).
authors.affiliation: Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Ido
authors.initials: I
authors.lastname: Nachmany
authors.forename: Igor
authors.initials: I
authors.lastname: Dvorchik
authors.forename: Michael
authors.initials: M
authors.lastname: Devera
authors.forename: Paulo
authors.initials: P
authors.lastname: Fontes
authors.forename: Anthony
authors.initials: A
authors.lastname: Demetris
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: James W
authors.initials: JW
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D015276:Health Care Rationing; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000191:economics / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: economics, other; ethics; liver clinical; outcome; quality of life, complications